Training oncologists (Oncs) to conduct better informed discussions with African American (AA) cancer (CA) patients (pts) about tumor genomic profiling (TGP): Results of a randomized pilot trial of gene pilot pro (GPP).
Authors: Michael J. Hall, Ariel Hoadley, Yana Chertock, Patrick J Kelly, Katie J Singley, Caseem C Luck, Sarah B Bass
Journal: Journal of Clinical Oncology (2023)

10552 Background: Molecular characterization of tumors to guide therapy choices using next-generation sequencing-based TGP has become standard practice for pts w/multiple CA types. AAs are more likely to have negative attitudes towards genetics, rooted in concerns about privacy, cost and discrimination, and higher mistrust of medical institutions. Oncs are poorly prepared for informed discussions w/CA pts about secondary hereditary risks of TGP and often fail to have these conversations despite 2015 ASCO guidelines benchmarking this standard, and further are poorly informed of the potential challenges of discussing TGP and germline risk w/their AA CA pts. Methods: Formative work included 1-on-1 interviews (n = 10) to assess oncs’ perceptions of TGP use and discussions w/AA CA pts, and a national survey (n = 50) to assess TGP practice patterns, communication of hereditary risk, and challenges encountered in AAs. Interviews/survey data and advisory board input informed development of GPP, a 12 min online training video to improve Oncs’ awareness of ASCO guidelines, confidence and preparation to have TGP discussions w/pts, and improve awareness of barriers to TGP unique to AA CA pts. The control consisted of 10 slides with information about TGP drawn from industry/academic websites and the 2015 ASCO guidelines. Participants (n = 63) completed baseline (100%), post-intervention (100%), and 1-month (95%) follow-up surveys. The study was approved by the Fox Chase Cancer Center IRB 18-8006. Results: Oncs were recruited by email and randomized to view GPP or control material. The majority were age 40-49 (38%), 71% male, 44% White, w/mean 15 yrs in practice; 85% reported none or only informal training to communicate TGP risks/results to pts. GPP produced a durable increase in recognition of 4 core ASCO guideline elements (20% baseline, 67% post, 63% 1 month). At 1-month follow-up, GPP significantly improved recognition of barriers specific to AA CA pts related to TGP and hereditary risk (p = 0.001) and promoted greater preparedness to support TGP discussions w/AA pts including preparedness to identify (p &lt; 0.01) and understand (p &lt; 0.01) issues that matter most to their AA pts. 1-month confidence to conduct difficult discussions related to genetic mistrust (p = 0.004) and TGP cost (p = 0.003) was better preserved after viewing GPP compared to control. Among Oncs viewing GPP, 90% agreed/strongly agreed that GPP helped them “better understand how to address concerns my AA pts may have about TGP” and 97% definitely/probably would recommend GPP to other Oncs. Conclusions: GPP significantly improved Oncs’ awareness of barriers related to TGP communication in AA CA pts, improved preparedness to facilitate informed decision-making, and supported sustained confidence to lead difficult discussions.